Itzhaki Ben Zadok Osnat, Murninkas Daniel, Iakobishvili Zaza, Jino Henri, Yohananov Esther, Birkenfeld Shlomo, Hasdai David
Department of Cardiology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Isr Med Assoc J. 2020 Jul;22(7):441-445.
Heart failure (HF) patients with reduced ejection fraction (HFrEF) are frequently treated with sub-optimal doses of angiotensin converting enzyme-inhibitors (ACE-Is), angiotensin receptor blockers (ARBs), and beta blockers (BBs).
To determine factors associated with attaining upper-range doses in patients with HFrEF.
We examined treatment in patients with left ventricular ejection fraction (LVEF) ≤ 40% in a community-based, dedicated heart-failure clinic. Upper-range doses were defined as ≥ 75% of target recommended doses by heart failure society guidelines.
The majority of the 215 patients were men (82%); median age at presentation 73 years (interquartile range [IQR] 65-78) and LVEF of 30% (IQR 25-35%). Following the up-titration program, 41% and 35% of patients achieved upper-range doses of ACE-Is/ARBs and BBs, respectively. Higher body mass index (BMI) was the only parameter found to be associated with achieving upper-range doses of ACE-I/ARBs (odds ratio [OR] 1.13, 95% confidence interval [95%CI] 1.05-1.22, P = 0.001). More patients achieved this target as BMI increased, with a sharp decline in the highest obesity category (BMI ≥ 40 m2/kg). Attaining upper-range doses of BBs was associated with pre-existing diabetes mellitus (DM) (OR 2.6, 95%CI 1.34-5.19, P = 0.005); women were associated with attaining lower BBs doses (OR 0.34, 95%CI 0.13-0.90, P = 0.031).
Achieving upper-range doses of ACE-Is/ARBs and BBs in HFrEF outpatients in a treatment up-titration program were associated with greater BMI and DM, respectively. These findings may serve as benchmarks for up-titration programs.
射血分数降低的心力衰竭（HFrEF）患者经常接受低于最佳剂量的血管紧张素转换酶抑制剂（ACE-Is）、血管紧张素受体阻滞剂（ARBs）和β受体阻滞剂（BBs）治疗。
确定与HFrEF患者达到较高剂量相关的因素。
我们在一个基于社区的专门心力衰竭诊所中检查了左心室射血分数（LVEF）≤40%的患者的治疗情况。较高剂量定义为心力衰竭学会指南推荐目标剂量的≥75%。
215名患者中大多数为男性（82%）；就诊时的中位年龄为73岁（四分位间距[IQR]65 - 78），LVEF为30%（IQR 25 - 35%）。按照滴定方案，分别有41%和35%的患者达到了ACE-Is/ARBs和BBs的较高剂量。较高的体重指数（BMI）是唯一与达到ACE-I/ARBs较高剂量相关的参数（比值比[OR]1.13，95%置信区间[95%CI]1.05 - 1.22，P = 0.001）。随着BMI增加，更多患者达到该目标，在最高肥胖类别（BMI≥40 m2/kg）中急剧下降。达到BBs较高剂量与既往糖尿病（DM）相关（OR 2.6，95%CI 1.34 - 5.19，P = 0.005）；女性与达到较低的BBs剂量相关（OR 0.34，95%CI 0.13 - 0.90，P = 0.031）。
在治疗滴定方案中，HFrEF门诊患者达到ACE-Is/ARBs和BBs的较高剂量分别与较高的BMI和DM相关。这些发现可作为滴定方案的基准。
